Ophthalmology and ENT Flashcards

A 5-year-old is found on routine screening to have best corrected visual acuity of 6/6 in the right eye and 6/60 in the left eye with no structural abnormality. What is the most effective treatment for the left eye?

Answer: Patching the right (good) eye for several hours per day

Amblyopia is treated by patching the stronger eye to force use of the amblyopic eye, stimulating visual cortex development during the critical period of visual plasticity.

A 45-year-old presents with a drooping left upper eyelid, a constricted left pupil that reacts poorly in dim light, and reduced sweating on the left side of the face. What is the diagnosis?

Answer: Left Horner syndrome

Horner syndrome consists of ipsilateral ptosis, miosis, and anhidrosis resulting from interruption of the sympathetic supply to the eye and face, and requires urgent investigation for underlying causes such as Pancoast tumor or carotid dissection.

A 52-year-old smoker presents with a firm, painless 3 cm neck mass that has been present for 8 weeks. Fine needle aspiration cytology reveals squamous cell carcinoma. What is the most important next investigative step?

Answer: Panendoscopy to identify the primary tumour

Metastatic SCC in the neck requires panendoscopy (examination of the nasopharynx, oropharynx, hypopharynx, larynx, and oesophagus) with biopsies to identify the primary tumour before definitive treatment planning.

A 61-year-old smoker presents with 8 weeks of progressive hoarseness. Flexible laryngoscopy reveals a lesion on the left true vocal cord with impaired mobility. What is the single most important next step in management?

Answer: Microlaryngoscopy and biopsy under general anaesthesia

Persistent hoarseness beyond 3 weeks in a smoker with a laryngeal lesion requires urgent microlaryngoscopy and biopsy to obtain histological diagnosis and exclude laryngeal carcinoma.

A 35-year-old presents with recurrent anterior epistaxis originating from the Kiesselbach plexus (Little's area). The bleeding is moderate and the patient is haemodynamically stable. What is the correct initial management?

Answer: Firm pinching of the soft part of the nose for 10-15 minutes while leaning forward

First-line management of anterior epistaxis is direct pressure by pinching the soft cartilaginous part of the nose for 10-15 minutes while the patient leans forward; this compresses the Kiesselbach plexus effectively.

Parents of a 6-year-old ask about tonsillectomy after their child had 7 documented episodes of streptococcal tonsillitis in the past year, each requiring antibiotics. According to the Paradise criteria, is this child a candidate for tonsillectomy?

Answer: Yes — 7 episodes in one year meets the threshold for tonsillectomy consideration

The Paradise criteria recommend tonsillectomy for 7 or more documented tonsillitis episodes in one year, 5 or more per year for two consecutive years, or 3 or more per year for three consecutive years.

A 63-year-old heavy smoker and drinker presents with progressive hoarseness, odynophagia, referred otalgia, and a palpable neck mass. Laryngoscopy reveals a supraglottic mass. Which investigation is most important for staging?

Answer: CT scan of the neck, chest, and upper abdomen with contrast

Contrast-enhanced CT of the neck, chest, and abdomen is essential for staging laryngeal carcinoma, assessing local tumour extent, regional lymph node involvement, and distant metastases to guide treatment planning.